Fat embolism syndrome is a serious manifestation of fat emboli causing multiple organ dysfunction with lung hypoxia manifesting with shortness of breath with confusion. This may be the direct result of long bone fractures and/or secondary to intramedullary reaming of the femoral canal during the surgical procedure of femur nail and screw fixation.
The two theories causing the syndrome are either a mechanical release of the fat droplets into the venous system or a metabolic stress response causing the changes in the chylomicrons to form fat emboli.
Presentation:
Acute respiratory distress and confusion. Clinical examination will show a tachycardia, tachypnea and petechiae rash in the axillary region, conjunctivae or oral mucosa.
Management:
- Prevention include early fracture stabilization within 24hrs
- Supportive with maintenance of haemodynamic stability and respiratory support with mechanical ventilation with high levels of PEEP (positive end expiratory pressure)